Surgical outcomes in recurrent glioma

Clinical article

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Object

The object of this study was to assess outcomes after surgery for recurrent intracranial glioma.

Methods

The authors retrospectively reviewed cases involving adult patients with intracranial glioma patients undergoing initial surgery (biopsy or resection) and one or more additional surgeries at their institution.

Results

A total of 323 operations were performed in 131 patients. The median survival was 76 months after first surgery, 36 months after second, 24 months after third, and 26.5 months after 4 or more surgeries. The overall complication rate was 12.8% after first surgery, 27.0% after second (OR 2.52, p = 0.0068), 22.0% after third (OR 1.92, not statistically significant [NS]), and 22.2% after 4 or more (OR 1.95, NS). Neurological complications occurred in 4.8% of patients at first surgery, 12.1% at second (OR 2.7, p = 0.0437), 8.2% at third (OR 1.75, NS), and 11.1% at 4 or more surgeries (OR 2.4583, NS). Regional complications occurred in 6.2% after first surgery, 9.9% after second surgery (OR 2.30, p = 0.095), 13.7% after third surgery (OR 3.31, p = 0.015), and 22.2% after 4 or more surgeries (OR 5.95, p = 0.056). Systemic complications occurred in 3.2% after first surgery, in 7.3% after second surgery (OR 2.3, p = 0.NS), in 4.1% after third surgery (OR 1.3, NS), and 0% after 4 or more surgeries. Reduction in Karnofsky Performance Status score occurred in 0% after first surgery, 8.1% after second surgery (OR 3.13, p = 0.0018), 10.2% after third surgery (OR 5.52, p < 0.0001), and 11.1% after 4 or more surgeries (OR 1.037, NS).

Conclusions

Postoperative survival is relatively prolonged but complication risk increases in patients with glioma who undergo multiple cranial surgeries. The largest increase in neurological risk occurs between the first and second surgery. In contrast, regional complication risk increases consistently with each surgery. The risk of systemic complications is not significantly altered with increasing surgeries. However, these complications only result in a modestly increased risk of functional decline after 2 or more surgeries. These findings may help counsel patients considering multiple glioma surgeries.

Abbreviations used in this paper:KPS = Karnofsky Performance Status; NS = not statistically significant; OR = odds ratio.

Article Information

Address correspondence to: Ian F. Parney, M.D., Ph.D., Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. email: parney.ian@mayo.edu.

Please include this information when citing this paper: published online March 15, 2013; DOI: 10.3171/2013.2.JNS121731.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Kaplan-Meier survival curves showing overall survival in months for all patients after first, second, third, or fourth surgery, regardless of grade.

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    Kaplan-Meier survival curves showing overall survival in months by tumor grade after first (A), second (B), third (C), or fourth (D) surgery.

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    Overall rate of complication after first, second, third, or 4 or more surgeries. Note that if multiple complications occurred in a single patient after a given surgery, this was counted as one event (that is, complications occurred) for the purpose of calculating overall complication frequency.

  • View in gallery

    Rate of neurological complications (A), regional complications (B), systemic complications (C), and functional decline (reduction in KPS score of ≥ 10) (D) after first, second, third, or 4 or more surgeries.

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